MEDICARE: JOHN JAMES DITMARS, JR. DPM, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213EP1101X	Primary Podiatric Medicine Podiatrist	142	OK
2	332B00000X	Durable Medical Equipment & Medical Supplies	142	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023286382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN JAMES DITMARS, JR. DPM, PC

Provider Business Mailing Address
First Line	:	PO BOX 717
Second Line	:
City	:	EL RENO
State	:	OK
Zip	:	73036-0717
Country	:	US
Telephone Number	:	405-262-6613
Fax Number	:	405-262-1088

Provider Business Practice Location Address
First Line	:	1620 W ELM ST
Second Line	:
City	:	EL RENO
State	:	OK
Zip	:	73036-4202
Country	:	US
Telephone Number	:	405-262-6613
Fax Number	:	405-262-1088

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN JAMES DITMARS JR.
Credential	:	DPM
Telephone Number	:	405-262-6613

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	03/04/2010

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